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Explore chapters and articles related to this topic
In Defense of a Trigger Point Patient: Trigger Points Are Myogenic, Not Psychogenic *
Published in Michael S. Margoles, Richard Weiner, Chronic PAIN, 2019
Many of us are familiar with Waddell’s signs for nonorganic pain. If a patient has three of the five signs, it is suggestive that the pain is not organic; however, further investigation is warranted. My experience has been that many patients’ reactions are misinterpreted by examiners unfamiliar with chronic pain patients and TrPs. A simple example of a commonly encountered misinterpretation is the “jump response.” Patient verbalization and physical withdrawal from palpitation of a TrP are a response well known and documented in the pain literature.
Validity of Waddell’s Sign
Published in Alan R. Hirsch, Neurological Malingering, 2018
The validity of Waddell’s Signs has been questioned and criticized in demonstrating nonorganic pain and malingering for secondary gain. The maneuvers performed in Waddell’s Signs tests are based on the reaction of the patient and how the initial findings are interpreted by the clinician performing the exam. These interpretations can lead to an observer bias, resulting in subjective findings. Waddell’s Signs can also be present in other medical conditions, such as fibromyalgia or complex regional pain syndrome, in which psychological factors are known to trigger pain (Littlejohn, 2015). Some examples of psychological factors include stress (from psychosocial events) and pain-anticipation, which are thought to initiate a cascade of events leading to elevated levels of substance P in C-fiber bodies within the dorsal root ganglia. This will further exacerbate the patient’s perception of pain (Eccleston, 2001). In addition, since Waddell’s Signs are subjective findings, given that the assessment is based upon the clinicians performing and scoring these tests, it is of critical importance to follow-up patient suffering from lower back pain with diagnostic imaging (i.e., MRI) to rule out nonorganic causes.
Psychosocial flag signs: impact on work status following a compensable shoulder injury
Published in European Journal of Physiotherapy, 2021
Dragana Boljanovic, Helen Razmjou, Amr Elmaraghy
The negative role of APR and positive Waddell’s signs on function and work status has been well-studied in patients with low back pain [15–22]. However, the features or prevalence of APR in patients with shoulder pathology has not been described or investigated and we are not aware of any formal research in this population.